運用突破性手法提升外科加護病房中心靜脈導管照護之專案

中心靜脈導管的照護不僅影響病人的治療同時也影響病人的住院品質，故第一線醫護人員必須具備知識和技術能力，避免病人在接受治療的過程中受到傷害。本專案旨在提升外科加護病房中心靜脈導管照護，專案期間自2014年2月1日至2014年10月15日，經現況分析發現確認中心靜脈導管相關血流感染率偏高6.4‰之問題，其原因為:放置中心靜脈導管流程正確率為84.5%、護理人員中心靜脈導管照護正確率為88%、缺乏執行放置中心靜脈導管流程及照護稽核方法、缺乏備物便利性設備。故藉由專案介入改善方案：舉辦「教育訓練課程」、製作「中心靜脈導管置放流程及照護指引手冊」、製作「置放流程及照護教學光碟」、製作中心靜脈導管「放置流程正確性查核表」、製作中心靜脈導管「照護正確性查核表」、製作中心靜脈導管「儘早拔除適應症檢核表」、成立「中心靜脈導管trace team」、設置中心靜脈導管「用物準備車」及「中心導管置放輔助安全架」等方案，經由醫護全面落實執行，增加中心靜脈導管照護完整性進而將低中心靜脈導管血流感染率，促進病患安全。

關鍵字

突破性手法；加護病房；中心導管

並列摘要

Careful insertion and maintenance of a central venous catheter (CVC) affect patient treatment and the quality of their hospitalization. It is therefore necessary for frontline medical employees to have the requisite professional knowledge and skills to avoid harming patients during treatment. The purpose of this project was to improve the completeness of CVC nursing. The project took place from February 1 to October 15, 2014. After analysis, results indicated that the CVC-related blood infection rate was slightly higher than 6.4‰. Infection causes were the accuracy of CVC placement (84.5%), the accuracy of CVC nursing (88%), the failure to evaluate CVC placement, and the lack of facilities. We thus proposed interventions to correct these deficiencies, namely holding nursing training courses, developing CVC placement and nursing standard operating procedures (SOPs), making an educational training DVD detailing SOPs, designing CVC nursing evaluation forms, producing CVC removal and adjustment instruction forms, and establishing a CVC trace team. Additionally, we propose that medical facility carts with CVC placement equipment should be prepared as well as the auxiliary frame. Through these interventions, which entail a series of improvement policies and deployment of an appropriately trained nursing staff, we aim to lower the incidence of CVC bloodstream infections and ensure patient safety.

並列關鍵字

central venous catheter (CVC) ； groundbreaking methods ； ICU

參考文獻

Kim, J. S, Holtom, P., & Vigen, C. (2011). Reduction of catheter-related bloodstream infections through the use of a central venous line bundle: Epidemiologic and economic consequences. American Journal of infection control, 39 (8), 640-646. doi:10.1016/j.ajic.2010.11.05

申斯靜(2005)．以病人安全為中心的醫療設備管理．慈濟醫學，17 (4)，35-45。